Referral Clerk
Referral Clerk
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Job Description
REFERRAL CLERK
TwentyNine Palms
AAI is actively looking for a referral Clerk. This position provides clerical/administrative support in the Referral Management Center forcustomer service referral tracking referral appointing and reporting activities. This position will supportthe daily functions of specialty care referral appointing referral review and coordination beneficiarycounseling and referral tracking at the MTF.
RESPONSIBILITIES:
- A fully qualified typist with a minimum of 50 WPM is required.
- Demonstrate general medical ethics telephone etiquette and excellent communication and customerservice skills.
- Possess general office administrative and clerical skills to perform receptionist duties and answertelephones.
- Ability to communicate effectively both orally and in writing.
- Work Environment/Physical Requirements. The work is primarily sedentary. However there may besome physical demands. Requirements include prolonged walking standing sitting or bending.
- Possess experience producing documents that require complex formats to edit update or rewrite to makeclear and revise existing complex word processing documents or spreadsheets. The contractor shall use varioussoftware applications to record retrieve correct merge query or print data and reports. Programs and softwareutilized by the Government and TRICARE contractor include but are not limited to Defense Enrollment EligibilityReporting System (DEERS) access to databases electronic fax applications Referral Management System/ReferralManagement System Tracking and Reports Healthcare Artifacts and Image Managements Solution (HAIMS) andElectronic Medical Record databases. The contractor shall use Microsoft Office products including: Outlook WordExcel and Access.
REQUIREMENTS:
- High school diploma or General Educational Development (GED) equivalency. Completion of an Administrative Assistant program is desired.
- At least 6 months of experience in medical office setting.
- Possess and maintain current certification in American Heart Association Basic Life Support (BLS) forHealthcare Providers. Training shall be the responsibility of the contractor and is at no cost to the workers not currently in possession of current certification must acquire certification prior to initiatingcontract performance. Web based classes do not meet these standards. Certification Card must display theAmerican Heart Association or Military Training Network Emblem.
UNIQUE MILITARY HEALTH CARE SYSTEMS/PROCEDURES:
- The MHS GENESIS or other MTF ICDB programs must be utilized for referral management services. Accesswill be granted by local MTF connectivity and the contractor shall comply with MHS communications andGovernment IT security standards and policies. The military facility will provide system accounts for MSSpersonnel after required training and security procedures have been completed by the contractor. If the Military Health Service processes moves away from specified systems the government will modify the task order
PERFORMANCE OUTCOMES:
Note: All specialty care and Right of First Refusal (ROFR) referrals/consults shall be managed per current DHAand MTF referral management policies and guidance. All specialty care referrals will be appointed to theMTF/Direct Care System within prescribed Access to Care (ATC) Standards or referred to the local network.
- Greets patients/visitors at a front desk referral center or office setting.
- Answers main office phone line(s). Directs telephone calls to appropriate section for assistancehandles independently or takes messages as required.
- Reviews all incoming CLR referrals for administrative accuracy completeness and legibility and posting ofconsultation reports for patients referred both to and from providers
- Determines patient eligibility for services arranges and schedules medical appointments forreferred care and contact the physicians office if an incoming report does not meet the CLR standards.
- Provides general instructions to patients and ensures patients have necessary documentation forreferred health care services.
- Obtains updates and files medical records as needed.
- Organizes and researches patient records extract needed information and review records for referralresults within established guidelines.
- Request medical records and ensures arrival of medical records prior to appointment(s).
- Initiates and locates patient medical records as needed. The contractor shall establish and maintain suspensefiles for referrals deferred to the network and compile and maintain data for reporting and tracking purposes.
- Obtains documentation as requested by healthcare providers (test results or documentation not yetfiled in records) and provide CLR receipts validation and shall crosscheck referral authorizations againstclaims adjudicated.
- Ensures referral results are returned to the referring provide and to the medical record within requiredtimelines. Assists with follow up written or verbal as necessary. Notifies MTF providers when a CLR is postedand monitor timelines of incoming CLRs.
- Utilizes the referral tracking data collection tool. Calculates metrics and compiles monthly statistic reportswhich includes the number of actions processed each month. It is estimated that approximately 20604administrative referral transactions will occur during a twelve 12 month period; to include telephone consults (Tcons)into MHS Genesis. The workload may increase depending on availability of specialists or specialty support
services at the MTF and unexpected influx in the number of beneficiaries to the area. - Contact Provider and network provider offices to determine if patient was seen and if so acquire referralresults. The contractor shall properly close referrals in MHS Genesis and the Referral Management System/ReferralManagement System Tracking Reports appropriately and shall forward an informational advisement of the referralstatus to the initiating MTF provider or PCM. Contacts shall be documented per MTF instruction.
- Properly document patient responses in MHS Genesis and the Referral Management
System/Referral Management System Tracking Reports and HAIMS. The contractor shall provide notification to thereferring Provider of patient requests to cancel referrals. - Assist with the return of completed consult reports to civilian providers for patients seen within the MTF underROFR. ROFRs shall be processed within the time limits outlined in the TRICARE Operations Manual Chapter 8Section 5 AAI
AAI is focused on delivering outstanding services to the federal government. We have extensive experience in the fields of cyber security development IT infrastructure supply chain management and other professional services such as system design and continuous improvement. AAI is a VA CVEcertified ServiceDisabled VeteranOwned Small Business (SDVOSB) SBA certified Economically Disadvantaged Woman Owned Small Business (EDWOSB) and a Woman Owned Small Business (WOSB) with offices in Hampton Roads Virginia Montgomery AL Washington DC and Atlanta.
Fully qualified candidates are welcome to apply directly on our website at: https://aaionline/.
Our benefits include:
- Paid Federal Holidays
- Robust Healthcare and Dental Insurance Options
- 401a plan
- 401k plan
- Paid vacation and sick leave
- Continuing education assistance
- Short Term / Long Term Disability & Life Insurance.
Veterans are encouraged to apply
AAI does not discriminate in employment opportunities terms and conditions of employment or practices on the basis of race age gender religious or political beliefs national origin or heritage disability sexual orientation or any characteristic protected by law. Pending guidance from the Safer Federal Workforce employees may in the future be required to provide evidence of COVID19 vaccination or request and receive approval for a medical or religious exemption.
Employment Type
Full-Time
